1891739306 NPI number — MRS. CYNTHIA LYNN DESMARAIS PT

Table of content: MRS. CYNTHIA LYNN DESMARAIS PT (NPI 1891739306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891739306 NPI number — MRS. CYNTHIA LYNN DESMARAIS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESMARAIS
Provider First Name:
CYNTHIA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FORBES
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891739306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2408 WHITNEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06518-3209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-626-0160
Provider Business Mailing Address Fax Number:
203-294-6734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2416 WHITNEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06518-3248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-407-3590
Provider Business Practice Location Address Fax Number:
203-466-8527
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  007651 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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